Obsessive Compulsive Disorder
What is Obsessive Compulsive Disorder (OCD)?
OCD has two distinct parts:
- Obsessions, which are an unwanted and unpleasant thoughts, images or urges that repeatedly enter our mind, causing feelings of anxiety, disgust or unease.
- Compulsions, which are repetitive behaviours or mental acts that make someone feel they need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought.
What are the causes of OCD?
As with most mental health problems, there is no one trigger to OCD. A mixture of biological tendencies, personality and life events can lead to OCD. For some people, OCD may come and go throughout their life, and may be linked to underlying negative views about themselves or learnt behaviour from their childhood. For others it is direct response to a stressor in their life. For example:
- A person is in a car accident, where they thought they may die. They become preoccupied with getting hurt and have frequent unwanted thoughts about dying. This feeling of things being out of control leads to relentless anxiety, which they try and manage through constant cleaning of their hands and their house, to keep them ‘safe’. They start to avoid situations which the perceive to be unsafe.
- An individual’s long-term partner splits up with them unexpectedly. They feel a strong sense of loss and question if they can cope alone. This leads them to question what they did wrong, whether they are a bad person, if it was their fault. This leads to intrusive, unwanted thoughts of harming others, which make them feel more guilty and bad. To combat this, they find themselves constantly checking that things have been switched off in the house, to the point that they struggle to leave a room because of compulsive checking of electric sockets.
- A person is in a highly stressful situation at work, where they feel bullied by their boss and fear they may lost their job. They find themselves in a constant anxious state at work, feeling unable to control this. When they get home, their anxious thoughts that they are a failure and things will go wrong lead them to find ways to feel better – this includes a ritual of walking up and down the stairs twenty times and flicking the light switches in every room ten times each time they enter/ leave a room.
It can be hard to identify the potential triggers to OCD without therapy; often people will feel that the thoughts and behaviours they have come from nowhere and are not in their control. This in itself causes high levels of distress, where they may think they are going ‘mad’. OCD can start as a means to feel more in control but leads to a greater sense of not being in control.
This becomes a cycle, see below:
What are the signs of OCD?
If someone has OCD, they will show certain routine behaviours excessively, to the point that it starts to impact on their lives. It may help to ask yourself the following questions:
- Do you wash or clean a lot? Either yourself or your home?
- Do you check things a lot? Maybe that things are turned off, doors are locked.
- Do you have certain rituals, maybe around counting?
- Is there any thought that keeps bothering you that you would like to get rid of but can not?
- Do your daily activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
- Do you avoid situations because you are worried they will trigger unwanted thoughts/ routines?
For some people, OCD will not include excessive compulsive behaviours, but obsessive and intrusive thoughts may make it hard for them to function day to day. Often, this will take the form of avoiding situations which they fear will trigger such thoughts.
What are intrusive thoughts, and do they mean I am a bad person?
Intrusive thoughts are unwanted, upsetting, frightening thoughts that enter your mind apparently from nowhere, which feel like you have little control over them. Trying to challenge them or telling yourself they are not ‘the truth’ can lead them to get worse.
Intrusive thoughts are more common than you may think. Many people have thoughts that come from nowhere, usually at inappropriate times, which shock them. These can be fleeting odd thoughts (maybe when you are daydreaming in a meeting), thoughts that are situation specific (i.e. only happen around a certain person) to recurring regular thoughts that are hard to switch off.
Intrusive thoughts are intrusive and shocking because they usually are the opposite or very different from your true values or beliefs. If someone has thoughts about offending god, religion is likely important to them. If they have thoughts of hurting others, they are likely to be caring.
Intrusions can include thinking and images relating to:
- Harm towards others or ourselves – these could include violent acts towards loved ones, or urges to hit a stranger in the street.
- Forbidden sexual actions – these may be to do sexual acts with people it is inappropriate to, or to do illegal sexual acts.
- Blasphemy (religion) – thoughts that are insulting about God.
- Disgust-causing actions – these are likely to occur when doing something pleasurable, and a thought comes up which stops this positive feeling – i.e. imagining someone spitting in food at a restaurant before eating it.
- Uncertainty of self – thoughts that make a person question any decisions they try to make ‘you won’t be able to do that’; ‘it’s the wrong choice’.
- Reality Questioning – these may include ‘I am losing my mind’; ‘I can’t think straight’ or ‘does my friend really like me?’
- Humiliating themselves socially – maybe thoughts of being sick in a restaurant, fainting on the street.
- Illness and Death – these may include images/ thoughts of bleeding to death, seeing your own coffin, having a car accident.
It can be helpful to imagine intrusive thoughts as a little demon or ‘imp’ (as discussed in Lee Baer’s book ‘The Imp of the Mind’). They seek out insecurities and makes the person aware of them.
Can you cure OCD?
Treatment for OCD may include anti-anxiety medication such as selective serotonin reuptake inhibitors (SSRI’s) and therapy.
Cognitive Behavioural Therapy is the recommended therapy for OCD in the UK. This differs slightly from ‘classic’ CBT in that the behavioural part is more the focus; this is because attempting to challenge OCD thoughts can escalate rumination and increase compulsive urges.
Some techniques that are used can include:
Exposure and response prevention (ERP):
This focuses on breaking down obsessions and compulsions and identifying situations which are fearful or avoided. The individual then creates a hierarchy of situations, and is encouraged to face these fears without having the compulsive behaviours. This starts with the most easy areas, before moving onto the harder ones.
Using techniques which allow the person to ‘surf the thought’, helping them to realise if they can tolerate it, it will go in the end.
Changing how they hear the voice in their head – either making it a humorous or singing the intrusive thoughts.
Cognitive diffusion exercises are a type of mindfulness that help people to notice their thoughts and then remove them, and allow them to go. For example, the ‘Leaves on a Stream’ mindfulness asks individuals to image being next to stream, and placing any thoughts onto leaves as they float past.
Gaining control of thoughts by having a specific time each day to think about them. This may 10 – 15 minutes where the individual either writes down or voice records thoughts as they happen; or they may use the time to mindfully notice their thoughts.
Is OCD a Personality Disorder?
OCD and Obsessive-Compulsive Personality Disorder are two different diagnoses.
OCD is often caused by a significant event in a person’s life, can be short term and focuses on the use of compulsive behaviours to try and stop current anxieties. It is distressing for the individual and they want it to stop. Obsessive Compulsive PD involves a lifelong need for routine, rules and order. This is likely to have developed through childhood experiences and will be seen in all areas of an individual’s life. People with OCPD rarely see problems in their behaviour, and believe that their way of doing things is correct – often to the detriment of relationships – and so are less likely to seek support.
Need further support?
If you think you have OCD you should firstly speak to your GP about your options. There are a number of OCD support groups including: